The New York State Board of Law Examiners ,Corporate Plaza, Building 3 – 254 Washington Avenue Extension Albany, NY 12203-5195

 
office (518) 453-5990
fax (518) 452-5729
TTY: Call 711 (nyrelay.com)
Phone Hours: Monday - Friday 8:30am – 4:30pm Eastern Time

Proctor Employment Forms

Form Description link
Direct Deposit Form REQUIRED for all new proctors.

Attach a canceled or voided check with form OR have form completed by bank PRIOR to submitting it to the Board. If voided check is submitted and it is a joint account, both account holders must sign the form.
Link
I9 Form and Instructions REQUIRED for all new proctors.

Employment Eligibility Verification

This form MUST be accompanied by proper identification to verify your identity and to authorize you to work as a proctor.
Link
W4 Form REQUIRED for all new proctors.

Complete so Board can withhold the correct federal income tax.
Link
IT-2104 REQUIRED for all new proctors.

Complete so Board can withhold correct state income tax
Link
Notice of Right to Membership in a Public Retirement System (USC-49) REQUIRED for all new proctors.

This form is required for all proctors, even if you are already a member of the New York State & Local Retirement System or a retiree.
Link
Dual Employment Form Only required for proctors currently employed by another NYS agency.

Present this form to your existing human resources department for approval and then send the completed form to:

NYS Board of Law Examiners -Corporate Plaza – Building 3, 254 Washington Ave Ext. Albany, NY 12203 (Attn: Employment Verification)
Link
Retirement Registration Form (RS 5420) Only required for proctors who wish to join the retirement system or are currently a member. Link
Retirement Beneficiary Form (RS 5127) Only required for proctors who wish to join the retirement system. Link
Tier 6 Retirement Plan Provided for proctors interested in information about Membership in Retirement Link